Provider Demographics
NPI:1720517592
Name:WOOLEY, TIFFANY EDE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:EDE
Last Name:WOOLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:TIFFANY
Other - Middle Name:MARIE
Other - Last Name:EDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2400 CANAL ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-6535
Mailing Address - Country:US
Mailing Address - Phone:504-507-2000
Mailing Address - Fax:
Practice Address - Street 1:2400 CANAL ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-6535
Practice Address - Country:US
Practice Address - Phone:800-935-8387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-06
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA305444363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant